Design recovery: Enlightening hospital design

Fancy spending a morning in Whittington Hospital’s Ambulatory Care centre? Thanks to some enlightened design and client thinking, you might not find it such a bleak place after all…

Words by Veronica Simpson

The Whittington hospital is at the forefront of a recent Department of Health initiative to develop an 'integrated care' model for the UK's currently struggling health services. In a nutshell, this means creating more efficient 'walk-in' services which can be accessed without the inconvenience (and cost to the NHS) of providing beds for people with long-term chronic conditions, such as obesity, diabetes, heart problems and mobility issues. Diagnostics, blood tests, specialist advice and consultation can be delivered in a day-care environment, relieving pressure on A&E and on the wards.

Having seen how well Studio Tilt's co-designing methods worked in the Whittington's Pharmacy redesign (in collaboration with Design Council) the chief executive at the time the project was commissioned, Yi Mien Koh, was happy to give Studio Tilt director Oliver Marlow carte blanche to suggest whatever changes in procurement or infrastructure emerged from a three-month consultation with all staff and stakeholders in the design of its new ambulatory care department. This is a huge deal, as anyone who has ever worked in healthcare design would know: red tape and impenetrable departmental silos have derailed many a well-intentioned design plan.

A mural of swimmers on the phlebotomy booth in a waiting/reception area gives both privacy and openness

The Whittington, like all major UK hospitals, is a patchwork of different eras and aesthetics, with Eighties' and more contemporary buildings grafted on to the Victorian original. As such it is almost impossible to make the user experience legible throughout the building. But after the intensive workshops, involving first small-scale and then full-scale prototyping of the scheme to ensure maximum efficiencies of flows and adjacencies, Studio Tilt's designs for a new 1,000 sq m ambulatory care department (for both adult and paediatrics) provided interior design practice Levitt Bernstein with the blueprint needed for a very different user and staff experience in the £3.5m completed scheme.

Says Marlow: 'The emphasis is on structuring the narratives.' Having identified the typical patient journey - lots of waiting around in often lifeless and dreary spaces, usually stripped down and gowned for medical intervention even when it turns out not to be required; patients often not visible to the medics who will be assessing or treating them because they are behind the closed doors of waiting or consulting rooms - Studio Tilt's solution was simplicity itself. It created two clearly defined waiting areas - one for assessment and one for treatment- within a large, semi open-plan department. It placed one central registration/nursing desk in each space so that medics can observe patients easily at every stage from these stations or the consulting rooms lining one wall.

The Paediatrics Department

With some simple interventions the scheme also makes each waiting area more humane. First it places them nearest to the exterior wall, so that large windows provide lots of daylight and views out on to the trees and greenery around the hospital. A small coffee bar was built into the first waiting/ reception area, to create a more welcoming environment for patients, friends and family who might be sitting with them.

And a large mural, depicting scenes of swimmers at Hampstead Heath ponds (by artist Alex Green), was commissioned to wrap around the rear wall of both waiting rooms. It even spreads around a curved-glass phlebotomy booth in the first waiting/ reception area, giving a level of both openness and privacy to patients who can now have their blood samples taken easily, fully clothed.

Allowing patients to keep their own clothes on up to the last minute also gives them the opportunity to wander elsewhere in the building, if needs be, for exercise or a change of scenery. The clinical space itself gives off a quietly busy and sociable hum, enhanced by the bustle of nurses and consultants; it creates a sense of life going on, in stark contrast to the stultifying purgatory of most hospital waiting spaces.

A waiting area

Sidestepping the typical boxy, cellular approach in favour of open-plan means that the waiting and treatment spaces converge. Treatment beds and chairs are all on wheels so that even patients on drips can be moved from the adjacent and curtained cubicles into the more sociable waiting spaces, all observable from the central desks and nursing stations.

Says Marlow: 'It's not so much about the patient experience as it is about the clinic being able to work seamlessly so that everyone there is happy with what they have around them; they are able to do their job better.'

Lead consultant, Natalie Richards, says: 'This was a unique experience. For us clinicians, being able to have free rein to think in a different way was brilliant. I think the environment definitely does impact on how people feel. It's also about the shared management of conditions, giving responsibility - and a sense of control - back to the patient. We do get lots of feedback about the space and how much better it feels.'

A BBC report on the opening in December 2014 declared: 'This is the sort of place that could help ease the strain on London's emergency health services. Instead of going to A&E, patients can come here daily, and spend their nights at home.' Norman Lamb, Government health minister, who opened the department, gave it a ringing endorsement: 'I confirm I have seen the future'.